Provider Demographics
NPI:1205850153
Name:CALDWELL, WILLIAM M JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
Last Name:CALDWELL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 WESTMINSTER PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-2664
Mailing Address - Country:US
Mailing Address - Phone:704-996-9376
Mailing Address - Fax:
Practice Address - Street 1:19460 OLD JETTON RD STE 204
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6581
Practice Address - Country:US
Practice Address - Phone:704-996-9376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2003-00949207Y00000X
NC200300949207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89135EHMedicaid
SC30096786OtherSELECT HEALTH OF SC
SCN0094BMedicaid
NC135EHOtherBCBSNC
SC771309OtherWELLCARE
NCP01027350OtherRAILROAD MEDICARE
NCNC0246AMedicare PIN
NC89135EHMedicaid
NCP01027350OtherRAILROAD MEDICARE